Accuracy of ECG interpretation in the pediatric emergency department

Joe E. Wathen, Arleta B. Rewers, Anji T. Yetman, Michael S. Schaffer

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Study objective: We assess accuracy of ECG interpretation and indications for obtaining ECGs and develop a clinical classification system of ECG abnormalities. Methods: Prospectively acquired ECG data on patients 0 to 21 years of age and presenting to our pediatric emergency department (ED) were obtained. Clinical indications were documented. The initial ECG interpretation (pediatric ED attending physician) was compared with the criterion standard (pediatric cardiologist). A blinded cardiology panel reviewed discrepancies, and a final concordance rate was determined. An ECG abnormality classification system was developed and used to categorize these abnormal ECGs. Results: One thousand six hundred fifty-three ECGs from 1,501 patients, aged 2 days to 21 years (median 10.0 years), were obtained during 3.5 years. Fifty-one percent were male patients. ECG indications included chest pain (21%), seizure or syncope (18%), arrhythmias (17%), apparent life-threatening event or respiratory symptoms (16%), ingestions (10%), cardiac abnormality (10%), and miscellaneous (8%). From 1,631 ECGs, 1,160 (71%) were normal (class 0), 259 (16%) were minimally abnormal (class I), 174 (11%) were moderately abnormal (class II), and 38 (2%) were severely abnormal (class III). Kendall's τ-b test showed concordance of 0.73 (95% confidence interval 0.70 to 0.77) between pediatric ED and cardiology interpretation. The sensitivity of pediatric ED interpretation was 75%, and the specificity was 98.5%. The positive predictive value of pediatric ED interpretation was 88.3%, and the negative predictive value was 96.3%. Conclusion: We conclude that, overall, a high rate of concordance exists between the pediatric emergency physician's and the cardiologist's ECG interpretation. The majority of discordant ECGs are not clinically significant. However, among the clinically significant ECGs, there is a higher rate of discordance. These data suggest that review of pediatric ECGs by pediatric cardiologists may significantly reduce underdetection of clinically important ECG findings in children.

Original languageEnglish (US)
Pages (from-to)507-511
Number of pages5
JournalAnnals of emergency medicine
Volume46
Issue number6
DOIs
StatePublished - Dec 1 2005

Fingerprint

Hospital Emergency Service
Electrocardiography
Pediatrics
Cardiology
Physicians
Syncope
Chest Pain
Cardiac Arrhythmias
Seizures
Emergencies
Eating
Confidence Intervals

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Accuracy of ECG interpretation in the pediatric emergency department. / Wathen, Joe E.; Rewers, Arleta B.; Yetman, Anji T.; Schaffer, Michael S.

In: Annals of emergency medicine, Vol. 46, No. 6, 01.12.2005, p. 507-511.

Research output: Contribution to journalArticle

Wathen, Joe E. ; Rewers, Arleta B. ; Yetman, Anji T. ; Schaffer, Michael S. / Accuracy of ECG interpretation in the pediatric emergency department. In: Annals of emergency medicine. 2005 ; Vol. 46, No. 6. pp. 507-511.
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abstract = "Study objective: We assess accuracy of ECG interpretation and indications for obtaining ECGs and develop a clinical classification system of ECG abnormalities. Methods: Prospectively acquired ECG data on patients 0 to 21 years of age and presenting to our pediatric emergency department (ED) were obtained. Clinical indications were documented. The initial ECG interpretation (pediatric ED attending physician) was compared with the criterion standard (pediatric cardiologist). A blinded cardiology panel reviewed discrepancies, and a final concordance rate was determined. An ECG abnormality classification system was developed and used to categorize these abnormal ECGs. Results: One thousand six hundred fifty-three ECGs from 1,501 patients, aged 2 days to 21 years (median 10.0 years), were obtained during 3.5 years. Fifty-one percent were male patients. ECG indications included chest pain (21{\%}), seizure or syncope (18{\%}), arrhythmias (17{\%}), apparent life-threatening event or respiratory symptoms (16{\%}), ingestions (10{\%}), cardiac abnormality (10{\%}), and miscellaneous (8{\%}). From 1,631 ECGs, 1,160 (71{\%}) were normal (class 0), 259 (16{\%}) were minimally abnormal (class I), 174 (11{\%}) were moderately abnormal (class II), and 38 (2{\%}) were severely abnormal (class III). Kendall's τ-b test showed concordance of 0.73 (95{\%} confidence interval 0.70 to 0.77) between pediatric ED and cardiology interpretation. The sensitivity of pediatric ED interpretation was 75{\%}, and the specificity was 98.5{\%}. The positive predictive value of pediatric ED interpretation was 88.3{\%}, and the negative predictive value was 96.3{\%}. Conclusion: We conclude that, overall, a high rate of concordance exists between the pediatric emergency physician's and the cardiologist's ECG interpretation. The majority of discordant ECGs are not clinically significant. However, among the clinically significant ECGs, there is a higher rate of discordance. These data suggest that review of pediatric ECGs by pediatric cardiologists may significantly reduce underdetection of clinically important ECG findings in children.",
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